=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740634856
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHY BONNY L.H.A.S., A.A.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2016
-----------------------------------------------------
Last Update Date | 04/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9858 GLADES RD STE D2
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33434-3983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-451-3626
-----------------------------------------------------
Fax | 561-451-0569
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9858 GLADES RD STE D2
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33434-3983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-451-3626
-----------------------------------------------------
Fax | 561-451-0569
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | AS5177
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2355A2700X
-----------------------------------------------------
Taxonomy Name | Audiology Assistant
-----------------------------------------------------
License Number | AI231
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------